The Truth About New Weight Loss Drugs – Benefits, Risks & Who Qualifies

My name is Sanjay Gupta. I'm a cardiologist in York. And today I'm delighted to be introducing to you Mr. Ja Onuri. Ja is a clinical pharmacist who specializes in cardioral metabolic medicine and heart failure. and he runs a primary weight management primary care weight management clinic which is commissioned by our lo local integrated care board the Humber and North Yorkshire ICB. Jay is also an expert speaker for Eli, Lily, Novatis, Nova, Nordisk, and Astroenica. And today we are going to predominantly be talking about some of these new weight loss uh drugs that are now very much in the media and a lot of celebrities are using them. But also, I wanted to find out whether they could help our patients. So J welcome. — Thank you Tanjay. Thank you for having me on your channel. — For listeners who are hearing about these drugs mainly through headlines or social media, what do we actually mean when we talk about the newer weight loss agents? What are they? How do they work? And how are they different from older approaches? — Thank you. Um so I think we kind of think they are newer weight loss agents but I'll give you a bit of history around uh where the weight loss medication journey or the current weight loss medications journey started. Um it we need to go back into 2009 uh when the first molecule called uh lagglutide um was licensed in the UK for treating type 2 diabetes um as a monotherapy or um along with metformin and other agents. Um what they found with that particular molecule, it's a daily injection. molecule is that people are losing quite a decent weight with it. Um hence the same company that made that molecule uh decided to relaunch the same product as Saxenda um exclusively for weight loss indication in 2017. So the same diabetes medication was reborn as Saxenda which audience might have heard about in 2017. Um and then come along so they tweaked the molecule they've seen the weight loss benefits of this particular medication along with HBA1C that is blood glucose reduction. Um and uh they tweaked the molecule to make it long acting in the body and they called it semiglutide. Uh one company called it semiglutide. The other company called it dulaglutide. Um which were marketed under the trade names of ompic which is known worldwide. Uh vigovi uh for weight loss uh indication is exactly the same molecule. Um and dull glutide which is truly uh mainly licensed only for type treatment of type two diabetes. Um then came along the they've seen the huge demand for these medications um especially during COVID um or just postcoid etc. And there was a big shortage of ampic because uh a lot of factories that were making these pens were shut down. Um the injectable pens um the demand outgrew the supply. Um meanwhile quietly um the American firm Eli Liille was uh working on uh the blockbuster uh um current medication calledide which is mangaro. Um and I was told that uh within the first year of its launch in UK they made3 billion pounds in terms of um you know revenue which I think is by far I feel it's um it's the leading pharmaceutical product in the whole world at the moment. Um yeah it's taken over one of the monoconal antibodies which was um used to treat um um autoimmune conditions um and and by far this this particular mangjaro treepide is now the leading pharmaceutical product um in terms of revenue generation. So that's the bit of history uh around weight loss medications. So we've had these agents since 2009. Uh but I think um the newer agent is the tepatide which is a dual um GIP GLP um blocker and uh has got profound uh weight loss effects. So could I ask you then are do you see these drugs primarily as weight loss medications or as treatments for metabolic disease such as type 2 diabetes and I guess why does that distinction matter? Um I think

if you think about it um now obesity uh itself uh do we need to classify and and who does classify now that in UK we are taking it a bit more serious post pandemic postcoid uh 19 pandemic it's one of the leading causes for cardiovascular disease and metabolic complications including some of the cancers so if you're thinking about in those terms um so we need. So people who've got a BMI over 30, that's height to weight ratio um of 30 kg per meter squared are classed as obese or people who've got um BMI of 27 or more along with uh one of the weight related co-orbidities. So you're talking about hypertension, dysipidemia, so high cholesterol, obstructive sleep apneoa, um cardiovascular disease, that's es is eskeemic heart disease or MI, pre-diabetes or type 2 diabetes. Um their threshold is slightly lower. So they fit into 27 NML category. So you're thinking about a large disease burdened population. Um hence I think we need to classify this medicine as um mainly for metabolic treatment. Okay. But we are addressing the the elephant in the room which is obesity which we have um I think uh stereotyped um thinking that uh it's just eat less uh more exercise but there's a lot of genetic element into it um in the current generation within our UK for example and I think people shouldn't be put off um uh into talking about these medications and we need to openly address um as It's a it's an epidemic uh in my opinion. Um and if we continue at this trajectory uh we are going to burden the NHS more and more. So for me it's a preventative medicine um uh as well as a treatment medicine. So if people have are just obese and they've [snorts] got no other co-orbidities I think they should be using it to bring them back into the normal BMI healthy BMI levels. people have got co-orbidities then they should be on it um to prevent further complications um and reduce hospital admissions. So in terms of when you were saying um who are these four what you're saying is if you are have a BMI of more than 27 with some coorbidity then you would be someone who would be eligible for this or if you are obese without a coorbidity uh so that would be a BMI of you said — 27 and above uh along with co-orbidities uh BMI over 30 and no co-orbidities. — Okay. And it's interesting, isn't it? Because you can still have the co com coorbidities. They just haven't met the definition of coorbidities. So, you know, you may still have the disease process going on in your body. And just because you've not hit that HBA1C level, you're not diagnosed as diabetic. But the whole idea is carrying too much weight is generally a bad thing for your health. And actually not only for that but also for your joints, also for your confidence in every way. Uh great, thank you. So then uh you know it's very interesting to me because I see a bunch of people and they'll come in and they'll have atrial fibrillation or hypertension, diabetes and it's clearly very obvious to me that we are just treating symptoms of the underlying problem which is that they carry too much weight. And whilst many people do really want to lose weight, it's a real struggle you know uh they try hard but when you are carrying a lot of weight it can be very difficult. And in those people I say well look you've got all these things and unless you lose the weight I think the burden of pills etc will just keep going up and I don't think we'll be making you a healthier person. So many of them say okay we are very much on board with what you're saying and we would like to try these medications but these medications are not easily available on the NHS despite the evidence and the scale of obesity and that may be due to costs commissioning capacity long-term data politics and privately they're very expensive so even though I see that there is a clear need for this in the right setting. Uh how come these people can't access it on the NHS? — Well, I'll give you some figures Sanjay on this one. So um it's a we said

that obesity is a growing public health concern. We said it's an epidemic, right? Um about 29% of the live um adults are living with obesity. Okay. And 64% living with overweight or obesity. So that's quite a large quarter population, right? and it continues to rise um as day goes on. Um and these statistics were published I think uh in 2022. Okay. And we are in 2025. So that might have already gone up by then. Um and if you think about it at this point of time when NHS England and NICE the National Institute of Clinical Excellence were sitting around and discussing about how do we commission this and what it's going to actually cost the taxpayer um because NHS money is nothing but taxpayers money right so they estimated um that it would cost them currently as it's about 11. 4 4 billion annually uh which could even rise up to 74. 3 billion a year and now you can understand um that you know trying to sort of monies to commission on top of treating existing conditions and the current NHS budget is a bit of a challenge both for the politicians uh and people running the NHS organization. So what they've done is actually um in a way they've categorized patients um into four cohorts and they said to the commissioners um locally you know so for example we've got Humber and North Yorkshire um and and where in England we've got different integrated care boards that have got the uh authority to commission these services. So what they said was let's figure out the highest risk patients. So the patients that whom we have to treat immediately now okay we call them cohort one high-risisk patients um and these are patients who've got BMI more than 40 now remember we were talking about obesity uh is just BMI greater than 30 right these patients um are BMI over 40 along with four qualifying co-orbidities that's hypertension they must have all four out of the five basically uh hypertension dysipidemia obstru obstructive sleep apopnea, cardiovascular disease, type two diabetes. If people have got four out of these five and their BMI is over 40, then they'll fall under the cohort one category. Okay. Um and um the the ICBs were given the flexibility to say cuz listen, you've got 12 months to sort these patients out first because these are the high-risisk patients. Let's commission them first. Okay. Next, they're talking about cohort 2. So that's BMI of 35 to 39. 9 along with four qualifying coorbidities. So that's again same thing hypertension, high cholesterol, dysipidemia, obstructive sleep apnea, cardiovascular disease and type two diabetes. Okay, that's the next cohort. Once we finish the first cohort um by about 2027 28 um we'll reach cohort three patients that BMI over than more than 40. However, they will only need three qualifying co-mobinities out of the five. Okay. So, um so they've given the commissioners to say this is the list that you got to work through in the order and this is the timeline. Okay. And you decide the funding models. You decide how you want to deliver this care. Uh and I think Humber and North Yorkshire are been proactive um and they have been um ahead of the game. I feel uh in terms of commissioning them in primary care in pharmacies um that specialize in weight management clinics and in our ICB we've got seven um pharmacies that um provide this service uh which patients can self-reer themselves um and we can you put the link to that or ask their GPS to refer them because if they do fall into the categories of cohort one um we are working through those lists at this point in time. So yeah, so due to the scale of economic burden, they've kind of are gently easing. So they're working on it and they're working at a pace that is um more suitable um uh and as the funding allows basically. So this is very interesting because you see in and again this is my ignorance but I've always sort of uh identified patients that I think would benefit and I refer them to our diabetic team because I was under the impression that our diabetic teams um will then assess their candidacy and they basically say well if he's not got if this patient doesn't have diabetes then sorry we just have to wait for this. But what you're saying is that actually there is a way for patients just to go ahead and access weight loss therapies on the NHS

provided they meet these four criteria. So and to my mind it's straightforward because anyone who comes to see me by usually has cardiovascular disease you know because I understand that there is no distinction cardiovascular disease is any form of cardiovascular disease. Uh there so anyone with a BMI of 40 who comes to see me has cardiovascular disease and most of them will either have will have the other two things. So uh at least two most of them will have sleep apnnea whether it's diagnosed or undiagnosed and most of them will have hypertension and impaired glucose tolerance. So what you're saying is that anyone who is listening to this who meets those criteria can selfreer — in our area — and access weight loss therapies on the NHS. — Yeah. And is this I know that you said Yorkshire area but presumably this is not available nationwide. It is just in the Yorkshire area. — Hamra North Yorkshire ICB um has commissioned this model. U now I understand there are various other models that have been commissioned at various other places. So um because the flexibility has been given to the local uh commissioning bodies uh different commissioning bodies have decided to do it differently. So I would suggest um anyone listening to this to contact the GP services or I wouldn't say to contact because we don't want calls going through tomorrow morning because JS said to ring the GP service. Um they will be informed. I mean there is a proactive uh approach for this um when comm um services like this are launched. um they usually patients do get coms uh about it. Um so uh and I think sometimes uh the system can get overwhelmed if everyone want starts to ring this. Now no only a few months ago um when uh NICE has released the guidance. Um the phone calls at GP surgeries were you know flooded with queries around am I eligible, am I eligible? — [clears throat] — every GB surgery has now got a a fact sheet on their website stating that we will contact you when if we think that you qualify for the service. So I would suggest that might be the case. Um we can include all the resources you know after the video in the link uh in the channel as to where to get those etc. Um but if you interestingly mentioned about diabetes Sanjay um primarily I I'm a diabetes clinician um I managed um diabetes in GP surgeries for the last six seven eight years um and if you think about diabetes um uh semiglutide um the molecule um under the trade name of rebels oric is eligible for type two diabetic patients. Mhm. — Now um it is a third line agent um you know rightfully so uh people try metformin max dose on metformin uh then they go on something called as an SGLT2 inhibitor which has got both cardiovascular and renal benefits um they're called the glyphlosins um and then the third agent and if people do meet uh the BMI of 35 and over um regardless to their HP1C I think they need to be initiated on a GLP A1 which is this semiglutide molecule. Um so uh again we don't have to wait for 40 um and having four F five co-obidities for diabetic cohort of patients if they've 35 and over BMI okay and they're on already two agents and [snorts] we're looking for a third agent to add in um not necessarily to reduce their blood glucose levels uh because the risk of these medications causing hypoglycemia which is low blood sugar event um is very — Okay. So, hence for the cardiovascular benefits, NICE has also said, okay, if the patients got a cardiovascular risk for these patients after these two agents and their BMI is over 35, you can simply add in uh semiglutide as a first line the GLP one or doulaglutide which is trulicity. So, uh I think these are the two widely available. There are other two but not widely used. So for them I think there's a bit more chance you know for just the diabetics whose BMI [clears throat] is over 35 um we're talking about BMI over 40 plus for four or five coorbidities right I think um it's you know for diabetic patients I think there's a lot more room uh if they're overweight and it if it does help uh reduce their weight — but my question is that let's say I have a BMI of 37

and I am not as yet diagnosed with diabetes but clearly my BMI is doing me some harm — suddenly — and I don't want to wait for 2 or 3 years for this harm to continue and more importantly why should I lose out on two or three years of life waiting [snorts] when I could actually be getting some weight off and actually enjoying my life with that weight off so to speak. So [snorts] people can potentially access these agents privately as well. And — my understanding is that there are weight management clinics now uh and those are run by pharmacies um and and people can just go and access them privately. So if someone came to you and said I get that the you know there's no money in the system at the moment and I'm not high risk. I'm not goh hot one but I'm worried and I want to be proactive about this. Who do you think then is okay? Well, can you give it to anyone? Do people who meet certain criteria privately? — Yeah. So, the same licensing indication applies. So, BMI over 30 um and they don't have to have any co-obilities. BMI over 30 is simply enough uh for us to provide these um medication. Um or if they are Southeast Asian or um other ethnic categories, then 27 is the BMI because they're at high risk. Um so for example, Asians like ourselves. So our BMI just needs to be 27 and more and we will be classed as obese rather than 30. Um so because genet genetically we are a lot more predispersed for pre-diabet for diabetes uh in general. So um so yes, private offering is massive at the moment uh within uh the pharmacy world and I would highly recommend and I've previously gone on uh local radio um BBC um um humbide uh cautioning patients to say please see a clinician on the ground, a pharmacist who can um assess your overall health for preventative uh care rather than simply going online and um getting these medications and one of the um uh things that we tend to do is that personalized care. So it's like investing in yourself Sanjay. Uh if you think about it um where would let's say £120 uh you know um where one of the molecule costs um go in terms of your health benefits um it's a month. So um I know when we look at in terms of we are traditionally used to uh getting um treatment free on the NHS um however uh if you look at the state of our NHS uh the burden the economic burden um uh each hospital admission for a cardiovascular admission as you would know uh um is it about 10 to 12 days of admission um let it be MI or heart failure um etc uh and that could cost typically around 12 to£15,000 um for the NHS um excluding the ambulance cost of transportation back and forth uh and the recovery of the patient including physiootherapy and what so though those are not included just the hospital stay alone is about 12 to 15,000 so uh and and we are at a stage where we are only trying to put a plaster over things rather than look at preventative medicine as a whole um for our health economy or health system in general. Um and um coming I mean my dad's a diabetic um and this is where my personal interest grew uh in terms of learning diabetes of why it's a cardium metatabolic disease how does it affect eyes feet etc and one of the first things I do Sanjay uh when I see my patients with newly diagnosed diabetic diabetics is do you know we can actually reverse this condition — because it's a symptom — it is a symptom yeah we need to reverse this and and they ask really how yes diet lifestyle okay we need to change the way we eat our habits in terms of our exercise our daily routines et and that is a biggest challenge that we'll face especially if we are you know juggling our work our life finances the stress and everything else so and my uh take on this and I'll always say to them is it's not as easy as I say it okay and I know it's

difficult because I come from a family where my dad's been there and we've kind of done this work on him. Okay. It's not just difficult for the patient but it's the family around that's supporting the patient as well. And I've successfully reversed my dad's diabetes. Um uh and I tell this personal story and I say I'll I'm putting myself in your family members shoes and I'm saying that yes we can reverse it and if you're 50 now your quality of life when you come to 70 okay is going to be much more meaningful and fruitful and that days out with grandchildren you know for or holidays that they want to do you know pretty much we spend our working life till about 60 65 grafting, you know, working 8 to 10 hours a day, you know, paying bills, etc. And then we'll have after 65 when we retire, we have about 10, 15 years of our good life. And do we actually get to spend that really good or we want to be achy uh visiting the doctors every 3 months for blood test, taking uh a dozen load of pills, rattling away, uh etc. with side effects because every medication comes with its own side effect. I mean I wouldn't I if I said that no medication is a side effect free uh I'll be lying to you as a pharmacist. Every medication has its own side effects. So, so you know it's a risk um benefit analysis that we do when we prescribe these medications as you know as a doctor. Um and and I always tell to the patient he says we need to prevent you going in one direction we need to go the other direction because I for me I'll be so happy if the customer comes even once a year during the flu season and buys some lips and things like that or some vitamins or some cough and cold remedies rather than taking a dozen load of pills every month in month out. Absolutely. And you know, I think also that the benefits of losing weight extend beyond just the metabolic harm — because the impact on your joints, confidence, the impact on your mental state, the impact on your sleep, they're all huge. And as we get older, it is not just the metabolic conditions that you end up being medicated for, but you're more likely to be on painkillers. anti-depressants. You're more likely to become frailer. And so again, carrying a lot of weight is bad in every possible way for patients. And if one can get the weight off, you know, ideally naturally, but that's difficult. I know how difficult that is. So, so I completely agree with you. Um what is interesting to me is obviously you're clearly someone who wants to practice ethical you know uh medicine and therefore you want to meet the patient you want to assess their risks. You want to see whether they're right for this. I guess a lot of these guys, the celebrities, people like that, they have they just go online and they acquire it because many of them probably don't even need it, but do it for for, you know, for their kind of — cosmetic reasons. I would — Yeah. So, I think I'm I'm completely against cosmetic reasons. Uh using medication for cosmetic reasons. Uh it's not ethical, but you know, it's against what I practice. Um it's definitely uh for those patients who carry that risk and we talked about those risk factors earlier on. Um going online it's bit of like a the unknown. Um you've got uh I mean in my town alone uh I have been presented with uh various uh bottles like till little vials of medication um uh saying that these are available on the market and uh a they're not licensed um b uh someone down the line is making some money uh with you know cashing on um uh fraudulently on people's uh need to lose weight. So um and I think uh there has been a big um uh raid by the MH on a factory down in Midlands um and they seized um a lot of counterfeit medicine. Um especially when when this has become the most popular search on Google um there will be fraudsters out there wanting to make money um and introduce fake medicines into the market um and there are you know people

locally and nationally doing this. So I would strongly advise patients um to speak to their pharmacist um you know who we have stringent measures on how we source medicine. Um we've got a supply chain uh record um along uh with storage records um to make sure the medicine that's going out is legit. Okay. along not just the medicine Sanjay it's easy to just order a medicine put it into the cart and and buy it but it's the advice it's the support um when to increase the dose what if you have side effects when to go to A&E because the one of the biggest concerns uh which the MH the NHS everyone else is uh campaigning about is pancreatitis it's a life-threatening condition that can happen very rare uh I don't want to um scare the audience about it. However, it can happen um and in which case what are the symptoms of pancotitis and how to and when you know who to approach uh for help etc. These are the things that you would get from us um or from doctors when or nurses when we when we see patients uh and counsel them. Each consultation roughly takes about an initial one takes about half an hour for me. a thorough consultation um going through how much water they drink uh what sort of nutritional do they have um how much exercise do they do what are the limitations for all these things etc so it's not simply you know I'll bring a box of medicine put in a bag and hand it out that's just not the case when we do consultations uh with our patients so I would recommend patients to speak to their pharmacist um make an appointment and we want to help to prevent the obesity. — Can I ask you one thing? I um I mean I agree with all that you want the right people to get the medications. Uh there may be people out there who have an unhealthy obsession with weight in which case by taking this you're actually making them worse you know people with eating disorders etc. So obviously there has to be that as well but actually if it's — it's a safeguarding element of that — there's a safeguarding issue but also to my mind are I mean I know about legitimacy and I also know about the fact that there's the support issue but are there instances where actually these medications that have been sold online to people that people can just buy online are they associated with harm? Have has there been any uh news about actually them being harmful more harmful than the real thing — to patient? — Y yeah closer to home than you think Sanjay in Selby uh there has been a case where the patients died of using such counterfeit medicine that they obtained from a local salon and so — they died. — Yes, they died. Yeah. — Great. So it becomes really important then that uh that they come to u proper ethical you know registered legitimate providers. Um okay so that all makes complete sense to me and I'm completely on board with everything you say. Uh there's two other questions. I think you've talked about the fact that uh there are risks and the risk of pancreatitis. Are there any other risks people need to be aware of? I mean dehydration, nausea, vomiting, profuse vomiting. Um they you know uh they need to be cautious about um I mean only today uh on the Facebook NHS is doing a campaign on uh you know if you feel sick uh you know completely dehydrated. So there's something called a sick day rules that we tend to follow. Um and uh um we tend to caution these patients. So let's say if you're unwell just pause the treatment for a while until you feel better and restart it again. Um jaundice for example you know because it affects the bile uh etc. So stomach ache sudden you know acute stomach ache with these patients that could be a sign of pancreatitis um lightadedness etc because it can lower your blood pressure um you know to an extent so I would say just check your blood pressure if you're feeling dizzy lightadedness etc. Um so yeah definitely um these are the main things to be worried about. um sudden onset of acute pain in your stomach um you know feeling you know dehydrated um feeling lightadedness um profuse vomiting or diarrhea both of them um uh just stop the treatment and seek urgent medical help um so you'll be seen to and also mention that you're on these medicines wherever you go um even A&E um to find for

them to think in the right direction because if you're getting them from private clinics, sometimes they're not always coded on your NHS records. So um it's quite important that you tell um the healthare professionals that you see um that these are um you know what you're on and no one's judging you by the way because we do believe that you know you are heading in the right direction you're taking the right decision. a clinician like me as Sanjay who are practicing ethically we you know we don't want to judge you and none of the healthare professionals in the NHS will judge you on that so don't think that you've got to hide the fact because um yeah — one um I came across a lady recently who's who' had a gallbladder out — and she said she's not eligible for this because her gallbladder is out is that correct — um yes so sometimes when it can irritate the gallbladder in general but It's not a um a contra indication as such. However, um there are cautions around it. Hence, it might not be a straightforward thing. Um or they might have had um uh pancitis in the past. — So, if someone has had a gallbladder out, it's still possibly worth them speaking to someone like yourself. — Yeah. to see whether they may still be able to cautiously — initiate and closely supervised and monitored for it. Yeah. — One final question I had J is what happens to your weight when you stop these medications. I think that's a very meaningful question Sanjay because um recent or in the news recently uh we've seen um uh comments or uh news that has been floating around saying that people are gaining one or two pounds a week when they stop these weightless medications. Now think about weight loss um as a journey. Okay, medication is only a quarter of it and the three quarters is uh your right state of mind. So people being mentally in the right frame to lose weight and to sustain it. Second one is uh diet. So the which is part of lifestyle change and the third thing is exercise. So the big part the majority part of the weight loss is about these three things. It's about the individual themselves. Okay. [snorts] So part of our weight loss consultation is about coaching these patients uh into thinking about the right things to eat uh right things to do uh activities wise yes I understand about mobility issues people who've got arthritis etc and there are um tailored exercises aquazima swimming where you know where it does suit your needs rather than we are strictly or regimentally saying run a marathon no that's not you know so when we call exercise that's what goes in our head right so but there are alternative ways to do um these exercises um so diet plays a big part um if you go into a supermarket I think before we reach any healthy uh section will be uh you know there'll be so many promotions um buy one get two offers um of unhealthy products now if the surrounding is doing that to you and working against you need to be mentally strong to think, "No, I'm not picking that. I am going to eat the right thing every day for the rest of my life. " And it's not boring. You can always have a treat. You know, there's always room for that. When you are healthy, there's more room for us to have indulgent. You know, we could be indulging in that ice cream or that nice steak that we want to eat. Um, you know, that fancy restaurant where we go in, there's a there's a lovely, you know, pork chop that we want. So all these things yes we can add those on but we need to be healthy first to enjoy those things. So that's the biggest thing and yes people do gain weight if they start stop suddenly um and without um having a plan as to how to tackle this um after stopping the medication. Now for normal patients uh people who've just got obesity I wouldn't say this is a lifelong medication um this is to get them to their target BMI and then we look at uh ways to reduce the dose uh and eventually come off it so that they can sustain a healthy lifestyle. Now I'll give you a simple example uh both in Christian terms and also um Hindu terms where my culture belongs to. So Lent is done for 45 days in Christian religion, right? Um now why particular that magic figure of 45 days? Okay, we I say you I'll give up chocolate for you know Lent. Okay. Um and then in our Hindu culture when we do something called as um there's a particular god called Ayapa and you do a 45day uh religiously um uh sleep on the floor

eat vegetarian food, pray every day. So that's also a 45day um uh program basically. Okay. And this 45 is a magic figure for some reason. Okay. Both in Christian culture and also in in Hindu culture. Um it's purely because if you do a certain activity for 45 days or longer religiously, okay, it becomes a habit, — right? — It becomes a habit. Your biological clock adjusts, okay, to doing those things repeatedly. Okay? Hence, you know, it's not that, oh, I'm going to [clears throat] eat that chocolate just after the lens finished. No. Okay. The idea is that we're trying to reset our biological clock for that 45 days to say your body doesn't crave that. We don't need that anymore. So, imagine we've got longer than 45 days during this weight loss consultations and period, you know, journey for a patient to lose weight because on an average people lose on these weight loss medications about a pound, you know, two pounds, somewhere up to 5 lbs. But to get to lose about few stone, it's about good six to eight months journey. So if we can sustain those good habits for 6 to 8 months, you know what their lifestyles changed. — They're not going to even if you offer it, they'll say, I don't need it. I don't crave for it anymore. So it's that whole um making them think or empowering them, okay, to make the right choices. And that's the center of, you know, what we do is patient centered care. We put them right in the middle and we say this is I'm giving I'm going to give you all the ammunition you need to get to where you want to. — Yeah. Absolutely. — And then they're winning first. We are winning with them because for me um a bad day at work is um where I couldn't help a patient win their goals. If they come to me and say I need to achieve this if I don't have a plan in place for them that's a bad day for me Sanjay you know but every day I go home and I can sleep better because every day I'm winning with my patients I'm making them feel better both psychologically physically um mentally and you know in terms of their overall health. So yeah there we are. I think um yeah it's like um for patients to understand that this is a bridge to a destination not the destination itself — not not for the majority of the healthy population who are just having obesity okay but if you think about diabetes or other coorbidities for them I think you know that needs to be there to protect their heart their kidneys on a long-term basis because they've already you know crossed that bridge and they are in that situation where they need these medication for their rest of their life. Whereas for the healthy population I would say healthy but actually if they've got obesity that's not healthy. Okay. But those that have got undiagnosed with any other conditions. Okay. Only when we start testing we'll know they got high blood pressure, high cholesterol. But a lot of these patients are busy working — to pay the bills you know their life in general. So dragging them out and trying to make them sit and doing a health check and making them given their realistic figures. you know, this is the trajectory you're going to take. I'll scare them honestly. — So, yeah, — one of my concerns is that the pharmaceutical companies that are producing these agents will recognize that um that they are so in demand and will raise the prices making it even more unaffordable. uh in ter and a lot of people are now worried about that because a lot of patients say well I don't think I can afford this privately you know because that kind of outlay even though there may be benefits later on in life which outweigh the outlay it's quite difficult for people to do you know um so my questions really are how expensive are these medications pats at this point in time and secondly if patients uh yeah largely how expensive are they? What are people looking at? So if you think about it the the original uh molecule of laglide which is now a generic um is about £50 a pen roughly about that price and it might last about 12 days but it's a daily injection. Okay. Uh if you're talking about Viggoi uh which is sort of the OMIC equivalent or the you know rebranded version for weight loss, — you're talking the starting price in my clinic is about £110. Um going up to you know the the maximum dose of 2. 4 is about £200 uh a month. 200 a

month. — So that covers you. So you're looking at somewhere between 110 to200 month of financial outlay. — Yeah. to be able to access Vigovi — Vikovi — and Mjaru — unfortunately [snorts] because of the geopolitical reasons u it was a lot more affordable okay until Donald Trump Mr. Trump decided that uh he needs to uh make it fair the uh for uh his uh people in the country paying the same amount as the rest of the world. Um UK was in such a privileged position because of our NHS I would say um that a lot of pharmaceutical manufacturers subsidize or reduce the price of the drugs just to get onto our NHS um list uh and and go about singing the rest of the world saying that we are on the list of uh you know for the UK's um market or the new NHS basically. So it started off being affordable. It was about £135 uh to start with a month. Um uh going up to about uh £220 maximum before uh since the prices have been increased. I mean I kept it fairly low. Um so the um starting at my clinic is about £159 um at the for the 2. 5 to going up to somewhere around 250 £260 uh for the highest dose or somewhere close to 300. I can't really remember because commercially I'm not that great. But um I kept the prices as low as possible um because I didn't want people um being not able to afford these medication and go on to online market and then get some counterfeit medicines thinking that they are real and get into trouble. So um uh hence I have got that bit of moral uh take on it and made it more affordable for patients which means my margins are low which is okay uh because the healthy patient I believe is going to come back and look at you know vitamins maybe to buy for example you know things like that so I look at the patient's relationship with me on a long term rather than a short-term you know they're not a cash cow to me um I I'd rather, you know, I want to know them. their family. children. I want to know their holidays. Uh, and that's the bread and butter of our community pharmacy. I mean, I where I, you know, practice in my, uh, town, people know me by my first name. They would know my children, they know my family, and likewise, I do know them. So, it's an ongoing conversation between us. Uh, each time we see, okay, how was your holiday? How did things go at the hospital? You know, what did the appointment? you know, I'm eagerly or you know, I want to know if they've gone for an MRI scan to think, okay, fingers crossed there's nothing sinister there um etc. So, uh I'm invested in my patients Sanjay um both for their health and well-being um and their longevity. I think this is so wonderful to hear because um everywhere it's becoming increasingly transactional and to meet people who are who still believe in that spirit of community is so important and so wonderful and so I guess my last question would be I'm sure people will buy into you — for what you say — as in addition into the the agent but buying into the person is so important to recognize this person as someone who is actually interested in helping is so important. So how do they contact you and allow you to become a member of their community or vice versa? — Absolutely. Uh I mean uh I I've realized that um uh I have to reach far and wide um not just you know serving my little community. So I've built an online platform where patients can fill in an online consultation. I contact them, I speak to them um and then I prescribe um when they're eligible for these treatments. Um and then they're free to get in touch whenever they like to speak to me. um because it's not just a you know sometimes um you know I could be busy with dispensary duties could be busy doing other things um but um when a patient calls you know I'm available and just picking the phone up and speaking to them um and a lot of your patients Sanjay uh do ring me um and only I think yeah uh yesterday day before yesterday um I had a what a call was about two minutes I turned out to be 10 minutes, 15 minutes conversation purely because um I didn't

want um them to think that they're just buying a product. It's just a sales thing. Um I was uh more interested in uh giving them the right ad advice and told them no I think you need to get in touch um you know with either Sanjay or your cardiologist before we you know initiate that medication because I think that's for me it's far more important um because uh as you said more and more it's transactional and I am not a transactional person my um business is not built on transactions. It's built on my ethos um around serving the communities um that I work for. — And you know, I can attest to that because you very kindly uh I think it was a year and a half ago, you kindly came along and said that I'm happy to take less profit to make more things affordable for your patients. And at that [clears throat] point we put out something on YouTube where we said that anyone in the country — could come along to you and you would give them their medications at a lower price than what they were paying uh as part of the kind of York cardiology initiative and I think this is also something you kindly also offered with these products where you said that actually you know we'll uh people who are watching this channel can access you and uh and you will try your hardest to make it possible for them to access the medications if you believe that it is the right thing for them and it can help them. So that's wonderful. Thank you so much. This is wonderful. — Thank you. Thanks. Thanks for giving me the opportunity to um address the audience. Um so yeah um how privileged I feel. — I'll put the links down for West Hill Pharmacy. the self-referral form that people can use — and also um you're part of the more than just medicine network. So anyone who goes to www. mtjm. co. uk can actually send you an email as well. So there's lots of ways of contacting you. My only worry is you'll become very busy after this. because I hope you will still be able to find the time to relax and uh and enjoy yourself and uh come back and do some more videos with us. — Thank you. Definitely. And um I've created an exclusive um QR code for yeah um so if you um want to access these medications through that QR code on the link uh then they'll have exclusive prices for you which are lower than what I'm currently offering uh to make it even more affordable. Yeah. Thank you. — No problem. Thanks, Sanjay. Thank you. — I'm going to stop recording now.